Spinal stenosis due to ossified lumbar lesions

Kawaguchi, Yoshiharu; Oya, Takeshi; Abe, Yumiko; Koike, Masahiko; Ishihara, Hirokazu; Yasuda, Taketoshi; Nogami, Shigeharu; Hori, Takeshi; Kimura, Takeshi

doi:10.3171/spi.2005.3.4.0262

Cited by 36 publications

(19 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some reports have shown correlations between preoperative mJOA scores or the duration of a preoperative symptom with postoperative outcomes [10]. In many studies, the classification for configuration of OLF failed to show any significance as a prognostic factor [8,10,14,15,22,23]. In our series, the classification of axial configuration into fused or non-fused types demonstrated a significant correlation to patient outcome.…”

Section: Discussionmentioning

confidence: 38%

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

et al. 2010

View full text Add to dashboard Cite

The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (n = 40) and the non-operative group (n = 66) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurologic status and postoperative outcomes of patients, as indicated by their modified Japanese Orthopedic Association (mJOA) scores and recovery rate (RR), Modic changes, the axial (fused or non-fused) and sagittal (omega or beak) configurations of OLF, and the ratios of the cross-sectional area (CSA) and anteroposterior diameter (APD) of the most compressed level were studied. The most commonly affected segment was the T10-11 vertebral body level (n = 49, 27.1%) and the least affected segment was the T7-8 level (n = 1, 0.6%). The ratios of the CSA in non-fused and fused types were 77.3 and 59.3% (p < 0.001). When Modic changes were present with OLF, initial mJOA score was found to be significantly lower than those without Modic change (7.62 vs. 9.09, p = 0.033). Neurological status improved after decompressive laminectomy without fusion (preoperative vs. last mJOA; 7.1 ± 2.01 vs. 8.57 ± 1.91, p < 0.001). However, one patient exhibited transient deterioration of her neurological status after surgery. In the axial configuration, fused-type OLF revealed a significant risk for a decreased postoperative mJOA score (0-7, severe and moderate) (Odds ratio: 5.54, χ (2) = 4.41, p = 0.036, 95% CI: 1.014-30.256). The results indicated that the new categorization of axial-type of OLF is a helpful predictor of postoperative patient outcome and fused type was related with poor prognosis. In OLF cases free from ventral lesions compressing the spinal cord, decompressive laminectomy is enough for successful surgical outcome. Therefore, early surgical treatment will be considered in cases with fused-type OLF compressing spinal cord even though they do not have myelopathic symptoms.

show abstract

Section: Discussionmentioning

confidence: 38%

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

et al. 2010

View full text Add to dashboard Cite

show abstract

“…In contrast, Chang et al [13] reported that the coexistence of thoracic OLF and other spinal disorders was related to poor outcome. Similarly, in the case of spinal stenosis due to ossiWed lumbar lesion, coexisting spinal lesions including thoracic OLF were associated with a poorer surgery related outcome [14]. A caveat of those studies was that they used heterogeneous cohorts with regard to several clinical factors, including the duration of the disease process before decompression, which appeared to have prognostic value in thoracic OLF [3,15,16].…”

Section: Discussionmentioning

confidence: 97%

Clinical characteristics and surgical outcome of the symptomatic ossification of ligamentum flavum at the thoracic level with combined lumbar spinal stenosis

Matsumoto

Harimaya

Doi

et al. 2011

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…On axial CT scans, the mean mass occupying ratio was 38.7% (range 16%-74.5%). The mean score on the mJOAS, as a reflection of clinical status, was 14.3 (range [8][9][10][11][12][13][14][15][16][17][18]. Figure 1 shows the average mJOAS score for each comorbid and radiographic condition.…”

Section: Cervical Opllmentioning

confidence: 99%

“…Cervical and thoracic OPLL typically manifests with signs and symptoms of myelopathy, while the lumbar disease usually manifests with signs and symptoms of stenosis. 17,27,29 Predictors and risk factors for the development or progression of myelopathy include > 60% OPLL-induced spinal stenosis, increased range of motion of the cervical spine, progression of OPLL, type of OPLL (that is, the segmental type is associated with the greatest risk), and lateral-deviated OPLL. [25][26][27]30 After 30 years, however, myelopathy-free rates as high as 71% have been reported among patients who had no myelopathy when the OPLL was first diagnosed.…”

mentioning

confidence: 99%

Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament

Kalb

Martirosyan

Pérez-Orribo

et al. 2011

FOC

View full text Add to dashboard Cite

Object Ossification of the posterior longitudinal ligament (OPLL) is a rare disease that results in progressive myeloradiculopathy related to pathological ossification of the ligament from unknown causes. Although it has long been considered a disease of Asian origin, this disorder is increasingly being recognized in European and North American populations. Herein the authors present demographic, radiographic, and comorbidity data from white patients with diagnosed OPLL as well as the outcomes of surgically treated patients. Methods Between 1999 and 2010, OPLL was diagnosed in 36 white patients at Barrow Neurological Institute. Patients were divided into 2 groups: a group of 33 patients with cervical OPLL and a group of 3 patients with thoracic or lumbar OPLL. Fifteen of these patients who had received operative treatment were analyzed separately. Imaging analysis focused on signal changes in the spinal cord, mass occupying ratio, signs of dural penetration, spinal levels involved, and subtype of OPLL. Surgical techniques included anterior cervical decompression and fusion with corpectomy, posterior laminectomy with fusion, posterior open-door laminoplasty, and anterior corpectomy combined with posterior laminectomy and fusion. Comorbidities, cigarette smoking, and previous spine surgeries were considered. Neurological function was assessed using a modified Japanese Orthopaedic Association Scale (mJOAS). Results A high-intensity signal on T2-weighted MR imaging and a history of cervical spine surgery correlated with worse mJOAS scores. Furthermore, mJOAS scores decreased as the occupying rate of the OPLL mass in the spinal canal increased. On radiographic analysis, the proportion of signs of dural penetration correlated with the OPLL subtype. A high mass occupying ratio of the OPLL was directly associated with the presence of dural penetration and high-intensity signal. In the surgical group, the rate of neurological improvement associated with an anterior approach was 58% compared with 31% for a posterior laminectomy. No complications were associated with any of the 4 types of surgical procedures. In 3 cases, symptoms had worsened at the last follow-up, with only a single case of disease progression. Laminoplasty was the only technique associated with a worse clinical outcome. There were no statistical differences (p > 0.05) between the type of surgical procedure or radiographic presentation and postoperative outcome. There was also no difference between the choice of surgical procedure performed and the number of spinal levels involved with OPLL. Conclusions Ossification of the posterior longitudinal ligament can no longer be viewed as a disease of the Asian population exclusively. Since OPLL among white populations is being diagnosed more frequently, surgeons must be aware of the most appropriate surgical option. The outcomes of the various surgical treatments among the different populations with OPLL appear similar. Compared with other procedures, however, anterior decompression led to the best neurological outcomes.

show abstract

Spinal stenosis due to ossified lumbar lesions

Cited by 36 publications

References 31 publications

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

Clinical characteristics and surgical outcome of the symptomatic ossification of ligamentum flavum at the thoracic level with combined lumbar spinal stenosis

Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament

Contact Info

Product

Resources

About